Provider Demographics
NPI:1174170088
Name:STICKELS, ANGELA (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STICKELS
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-0607
Mailing Address - Country:US
Mailing Address - Phone:817-264-7009
Mailing Address - Fax:
Practice Address - Street 1:9946 E BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2642
Practice Address - Country:US
Practice Address - Phone:817-264-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14055101YA0400X
TX78112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)